Bouveret’s syndrome as a rare cause of gallstone ileus: A surgical challenge

Introduction: Bouveret syndrome, a rare cause of gastrointestinal outlet obstruction, was first described by Beassier in 1770. Afterward, this condition was named after Leon Bouveret in 1896. Bouveret syndrome is characterized by the passage of a gallstone through a cholecystogastric or more commonly through a cholecystoduodenal fistula, causing obstruction. Case Report: A 70-year-old male patient without chronic degenerative diseases and with history of epigastric pain months prior to his current evaluation. Five days before hospital admission, the patient experienced worsening of the epigastric pain with an intensity of 8/10 accompanied by anorexia, vomiting, jaundice, and choluria. Physical examination with evidence of generalized jaundice ++, painful and distended abdomen in the upper right quadrant. Diagnostic protocol was initiated based on preoperative tests, which showed hyperbilirubinemia of 2.78 mg/dL with an obstructive pattern and alteration of liver function tests. The hepatobiliary ultrasound showed a lithiasic sclero-atrophic gallbladder, a common bile duct diameter of 5 mm and positive sonographic murphy sign. The patient was taken to the operating room where, after general anesthesia and in a supine position, a 13 mmHg pneumoperitoneum was created and laparoscopic working ports were introduced. A laparoscopic cholecystectomy + trancystic cholangiography + resection of the cholecystoduodenal fistula were performed. Conclusion: A high degree of clinical suspicion and imaging studies are required to establish Bouveret syndrome diagnosis, nevertheless in 50% of cases, the diagnosis is made intraoperatively. Early diagnosis and adequate surgical intervention are essential for a favorable prognosis.